City of
Horn Lake
Mississippi
Government
Departments
Agendas & Minutes
Visiting
Living Here
How Do I?
City Application
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W10=
City Application
*
Position Applying For
*
Name
Last, First, Middle
*
Address
Number, Street, City, State, Zip
*
Email Address
*
Phone
Date Of Birth
Social Security Number
Do you have a valid driver's license?
Yes
No
State Issued
If you are under 18 years of age, can you provide proof of your eligibility to work?
Yes
No
Have you ever been employed by the City of Horn Lake?
Yes
No
If yes, provide dates
Do any of your friends or relatives work here?
Yes
No
If yes, provide name, relationship and department
Have you ever been convicted of, or plead guilty or no contest to, a crime other than a minor traffic violation?
Yes
No
Are you currently employed?
Yes
No
May we contact your present employer?
Yes
No
Are you a U.S. citizen, or are you legally authorized to work in the U.S.?
Yes
No
NOTE: Proof of citizenship or authorization to work in the United States may be required.
On what date would you be available to begin work?
Are you available to work?
Full Time
Part Time
Shift
Are you currently on “lay-off” status and subject to recall?
Yes
No
Will you be able to travel if the job requires such?
Yes
No
Employment History
Employer, Work Dates, Location, Contact
EDUCATION
High School
Name and Address of School
Received:
Diploma
None
Other
College, University or Professional School
Name and Location of School, Course of Study, Credit Hours Earned, Did you graduate? Degree
Job-Related Training or Course Work
Name and Location of School How many years did you attend? Course of Study
Describe any specialized training, skill, or qualifications you possess (ex: speak any language other than English, operate specialty equipment)
List professional, trade, business, or civic activities and offices held, if applicable. (You may exclude memberships, which would reveal sex, religion, national origin, age, ancestry, handicap or other protected status)
Upload Employment History and References
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